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The Role of Fat Transfer in Breast Augmentation

The Role of Fat Transfer in MTF Breast Augmentation

Breast Augmentation Before & After Photos

Gender-Affirming Breast Augmentation is a surgery procedure that transgender and non-binary individuals may seek to increase breast size and improve chest shape. While hormone therapy can slightly increase breast volume, enhancing the feminine shape and contour of the breasts can further alleviate gender dysphoria, and improve confidence and self-esteem. One study found that nearly 70% of transfeminine patients had Breast Augmentation to reduce the distress associated with a difference between gender expression and gender assigned-at-birth. Breast Augmentation is a medically necessary procedure that improves quality of life for these patients.

Breast Augmentation typically involves placing breast implants under breast tissue. Fat Transfer or Fat Grafting, where fat is taken from other parts of the body (liposuction) and injected into the breasts, is another technique that is sometimes used on its own or in conjunction with breast implants.

Fat Transfer has some appealing benefits:

  • Moving fat from where you don't want it to where you do!
  • No implants used = No risk of capsular contracture
  • Small incisions, low scarring
  • Minimal risks

Fat Transfer Breast Augmentation on its own is limited in how much breast volume it can contribute however, and multiple procedures may be required due to fat reabsorption. One study calculated the fat reabsorption rate at 32.9%. Additionally, 2.9% of patients developed fat necrosis while cyst formation occurred in 17.6%.

Montreal Plastic Surgeon & Facial Feminization specialist Dr. Eric Bensimon"Fat Grafting is generally good for small volume or contour correction. In best case scenarios,  it increases one cup size," says Montreal Plastic Surgeon & Facial Feminization specialist Dr. Eric Bensimon. "It is associated with a high rate of problems and complications like fat necrosis, oily cysts, lumpiness, irregularity. I don't personally do it for those reasons."

There's evidence that breast "pre-expansion" can greatly increase the volume of fat that can be transferred to the breasts. The Brava® technique consists of a bra-like device that uses gentle negative pressure (vacuum) to gradually expand the breasts for up to three months prior to Fat Transfer. But with pre-expansion, plus the potential for multiple Fat Transfer procedures to account for fat reabsorption, Fat Transfer Breast Augmentation seems neither affordable or efficient.

Dr. Michael Beckenstein, a Plastic Surgeon in Birmingham, Alabama who performs MTF Breast Augmentation"It is a costly process that requires multiple surgeries and use of the Brava system to be effective. Most insurance won't cover it either. Implants are a good 'one and done' option," says Dr. Michael Beckenstein, a Plastic Surgeon in Birmingham, Alabama who performs MTF Breast Augmentation.

Fat Transfer As a Complimentary Procedure in Breast Augmentation

If Fat Transfer Breast Augmentation on its own is an insufficient solution, what role can Fat Transfer play in feminizing the chest? Fat Transfer can be used to improve the natural appearance and feel of the female breast. Using Fat Grafting in conjunction with breast implants can be especially useful for trans women. Fat Grafting allows the surgeon to construct areas of the breast that are difficult or impossible to create with smooth, round implants alone.

Dr. Jonathan Keith, a Plastic Surgeon in New Jersey who performs the full spectrum of gender-affirming procedures"For many trans women with a wider sternum and therefore increased space between breast tissue, Fat Grafting is a very important tool to create an attractive decolletage (cleavage plane) and tail of spence areas," says Dr. Jonathan Keith, a Gender Surgeon in New Jersey who performs the full spectrum of gender-affirming procedures.

Other Gender Surgeons have predicted that Fat Transfer Breast Augmentation will rise in popularity:

"It is possible that autologous tissue breast reconstruction will be covered by insurance. Because of the straightforward microsurgical approaches, potential improved cost-to-benefit ratios, and avoidance of breast implant-associated anaplastic large cell lymphoma and breast implant illness, we foresee that autologous reconstructions may be increasingly requested by transgender and gender nonbinary patients. High-quality studies focusing on outcomes should be developed."

While Fat Transfer on its own has limitations for increasing breast volume, Fat Transfer used as a complimentary procedure to breast implant surgery can create a natural, feminine appearance to the breasts, improving quality of life for transfeminine individuals.

Last updated: 04/04/20